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ﻃﺐ اﻷزﻫﺮ Cases Digested MP3s
ﻃﺮﻳﻘﺔ ﺣﻞ ﺍﻟﻤﺴﺎﺋﻞ
ﻋﺎﻳﺰﻳﻦ ﻧﻌﺮﻑ ﻃﺮﻕ ﺣﻞ ﺍﻭ ﺍﻧﻮﺍﻉ ﺍﻟﻤﺴﺎﺋﻞ ﻓﻴﻪ ﺣﻮﺍﻟﻲ 76ﻧﻮﻉ ﻣﻦ ﺍﻟﻤﺴﺎﺋﻞ ﻭﻧﺨﺘﺼﺮﻫﻢ ﺍﻟﻰ ﺍﺭﺑﻌﺔ
ﺍﻧﻮﺍﻉ ﺑﺎﻟﻜﺘﻴﺮ
النوع األول
ﻣﺴﺎﻟﺔ ﺗﺘﺤﺪﺙ ﻋﻦ ﻧﻔﺴﻬﺎ ﻭﺃﻱ ﻣﺴﺎﻟﺔ ﻭﺍﺿﺤﺔ ﻻ ﻳﺨﺘﻠﻒ ﻋﻠﻴﻬﺎ ﺍﺗﻨﻴﻦ
ﻣﺜﺎﻝ
Female 20 y complaining of arthropathy , erythema in face and was treated with
cortisone
ﻫﻞ ﻣﻤﻜﻦ ﻧﺨﺘﻠﻒ ﻋﻠﻰ ﺍﻥ ﺍﻟﺤﺎﻟﺔ ﺩﻱ ﺍﻛﻴﺪ ﻫﺘﻜﻮﻥS.L.E
المسأله التانيه
ﺍﻟﻤﺴﺄﻟﻪ ﻣﺶ ﺑﺘﺘﺤﺪﺙ ﻋﻦ ﻧﻔﺴﻬﺎ ﺑﺲ ﻟﻴﻬﺎ ﻃﺎﻟﻌﻪ ﺷﻬﻴﺮﻩ ﻳﻌﻨﻲ ﺃﻭﻝ ﺍﻧﻄﺒﺎﻉ ﻳﺒﺪﺃ ﺑﺠﻤﻠﻪ ﺷﻬﻴﺮﻩ
ﻣﺜﺎﻝ
Old male heavy smoker _______ bronchogenic carcinoma
______________ Old male complaining of polyache and elevated ESR above 100
multiple myloma
النوع التالت
ﻣﺴﺎﻟﺔ ﻻﺗﺘﺤﺪﺙ ﻋﻦ ﻧﻔﺴﻬﺎ ﻭﺧﺎﻟﻴﻪ ﻣﻦ ﺍﻟﻄﻠﻌﺎﺕ ﺑﺲ ﻓﻴﻬﺎ common s&sﻭﻛﻤﺎﻥ almost
specificﺧﺪ ﺑﺎﻟﻚ ﻣﻦ ﺍﻟﻤﻌﻨﻰ ﻣﺜﺎﻝ ﻋﻤﺎﻝ ﻳﺤﻜﻲ ﻭﻳﺤﻜﻲ ﻭﻓﻲ ﺍﻟﻨﺺ ﺟﺎﻳﻠﻚ hematemsisﻳﺒﻘﻰ
ﻫﻲ ﺍﻟﻤﻮﺿﻮﻉ ﺍﻣﺴﻜﻬﺎ ﻭﺃﺷﻮﻑ ﺇﻳﻪ ﺍﻟﺤﺎﺟﺎﺕ ﺇﻟﻲ ﻣﻤﻜﻦ ﺗﻌﻤﻠﻬﺎ ﻭﺍﺷﺘﻐﻞ ﺍﻟﻤﻮﺿﻮﻉ ﻛﻠﻪ ﻋﻠﻰ
ﺍﻷﺳﺒﺎﺏ ﺩﻱ
ﻭﻧﺸﻮﻑ
ﻃﺐ ﻫﻮ ﻳﻌﻨﻲ ﺇﻳﻪ common symptomsﻳﻌﻨﻲ ﺇﻳﻪ ﻳﻌﻨﻲ ﻟﻴﻪ ﺃﺳﺒﺎﺏ ﻣﺘﻌﺪﺩﺓ ﻭﻣﻌﺮﻭﻓﻪ ﺯﻯ
Frank hemoptysis
ﻃﻴﺐ
ﺃﻻﻗﻴﻪ ﻓﻴﻦ pulsus paradoxicus
• cardiac temponad
• acute severe asthma
ﻣﺜﺎﻝ
ﻟﻮ ﺍﻟﻤﺮﻳﺾ dyspnicﻭﻣﻌﺎﻩ chest pain
ﺍﻟﺤﺎﺟﺎﺕ ﺇﻟﻲ ﺑﺘﻌﻤﻞ chest painﻛﺘﻴﺮ ﺑﺲ ﻣﻊ ﻭﺟﻮﺩdyspnea
ﺑﻴﺘﻮﺟﻪ ﺗﻔﻜﻴﺮﻧﺎ ﻟﺤﺎﺟﺎﺕ ﻣﻌﻴﻨﻪ ﺑﻤﻌﻨﻰ ﺍﻥ s&sﻣﺪﻣﺠﻴﻦ ﻣﻊ ﺑﻌﺾ ﻳﺸﻴﺮﻭﺍ ﻭﻳﺤﺼﺮﻭﺍ ﺍﻻﺣﺘﻤﺎﻻﺕ ﻓﻲ
ﻋﺪﺩ ﻣﻌﻴﻦ ﻣﻦ ﺍﻻﺣﺘﻤﺎﻻﺕ
ﻣﺜﺎﻝ
hematemsis
ﻳﺒﻘﻰ ﻋﺎﻳﺰﻙ ﺗﺘﻜﻠﻢ ﻋﻦ ﺇﻳﻪ
ﻋﻦ ﺇﻝ s&sﺑﺘﺎﻋﺔ ﻣﺜﻼ ﺗﻼﺗﻪ ﻣﻦ ﺍﻟﺤﺎﺟﺎﺕ ﺇﻟﻲ ﺑﺘﺴﺒﺒﻪ ﺯﻯ
) ( rupture varises – duodenal ulcer – gastric ulcer
ﻭﺍﻟﺠﻤﻴﻞ ﻓﻲ ﻛﺪﻩ ﺍﻧﻚ ﻫﺘﻜﻮﻥ ﺣﻮﻟﺖ ﺍﻟﺤﺎﻻﺕ ﻣﻦ ﺣﺎﻟﻪ ﻝ essayﺑﺲ short
ﻫﻤﺴﻚ ﻭﺍﺣﺪ ﻭﺍﺣﺪ ﻣﻦ ﺍﻷﻣﺮﺍﺽ ﺇﻟﻲ ﺍﻧﺎ ﺗﻮﺻﻠﺖ ﺇﻟﻴﻬﺎ ﻭﺍﺑﺪﺃ ﺍﻃﻠﻊ ﻣﻨﻬﺎ ﺍﻷﻋﺮﺍﺽ ﻭﺍﻟﻌﻼﻣﺎﺕ ﺇﻟﻲ
ﻫﺘﻜﻮﻥ ﻋﻨﺪ ﺍﻟﻤﺮﻳﺾ ﻗﺒﻞ ﺍﻟﻤﺮﺣﻠﺔ ﺩﻱ
ﻣﺜﺎﻝ
Esophageal varises __________ portal hyper tension
liver cirrhosis and splenomegalyﺇﻳﻪ ﺃﻋﺮﺍﺿﻪ
ﻃﺐ ﻟﻴﻪ ؟؟؟؟varises ﻭﻫﻨﺎ ﺍﻟﺤﺎﻟﺔ ﺩﻱ ﻏﺎﻟﺒﺎ ﻫﺘﻜﻮﻥ
painﻷﻧﻪ ﻫﻨﺎ ﻣﺬﻛﺮﺵ ﻭﺟﻮﺩ
Painless melena = rupture varises
Painful melena = peptic ulcer
Investigation ??
Upper endoscope
Treatment ???
ﻫﻤﺴﻚ ﻛﻞ ﻣﺮﺽ ﻣﻦ ﺍﻷﻣﺮﺍﺽ ﺇﻟﻲ ﺫﻛﺮﺗﻬﻢ ﻭﺍﻛﺘﺐ ﻋﻼﺟﻪ ﻛﻞ ﻋﻠﻰ ﺣﺪﻩ ﺑﺲ ﺧﺪ ﺑﺎﻟﻚ
collapseﺍﻟﻤﺮﻳﺾ ﺩﺍﺧﻞ ﻓﻲ
ﻳﻌﻨﻲ ﺇﻳﻪ ؟؟؟
Hepatic encephalopathy
ﻓﻼﺯﻡ ﺗﺒﺪﺃ ﺍﻟﻌﻼﺝ ﺑﻌﻼﺟﻬﺎ ﺃﻭﻻ
84 مايو
57 OLD MAN WAS ENTER IN SHOCK AFTER VOMIT ING LARGE AMOUNT OF DARK
BROWN VOMITS BL. TRANSFUSION TO H IM AND THEN HE WAS CONFUSED AND
COMATOSED
الحالة الثالثة
ﺣﺎﻭﻝ ﺗﺤﻂ ﻋﻨﻮﺍﻥ ﻣﻌﺎﻳﺎ ﻟﻠﺤﺎﻟﺔ ﺩﻱ ﺍﻋﺘﺒﺮﻫﺎ ﻓﻴﻠﻢ ﻭﺣﻄﻠﻪ ﻋﻨﻮﺍﻥ ﺑﺲ ﺍﻗﺪﺭ ﺍﻛﺘﺐ ﻋﻠﻴﻬﺎ ﻋﻨﻮﺍﻥ ﺇﻳﻪ
ﻣﺸﻬﻮﺭ
ﺳﺆﺍﻝ
What are signs ?
cl / pﺍﻧﺎ ﺣﻄﻴﺖ ﺗﻠﺖ ﺃﺳﺒﺎﺏ ﺍﻣﺴﻜﻬﻢ ﻭﺃﺷﻮﻑ ﺇﻝ
leukemiaﻃﻴﺐ ﺍﻣﺴﻚ ﺇﻝ
ﺑﻤﺎ ﺍﻧﻬﺎ ﻓﻲ ﻃﻔﻠﻪ ﻓﻐﺎﻟﺒﺎ ﻫﺘﻜﻮﻥ ﺇﻳﻪ ؟
Acute leukemia
ﻫﺪﻭﺭ ﻋﻠﻰ ﺇﻳﻪ
Liver •
Spleen •
Lymph node •
ﻭﺍﺧﺪ ﺑﺎﻟﻲ ﺍﻥ ﻓﻴﻪ ﺣﺎﺟﻪ ﻣﻤﻜﻦ ﺗﻌﻤﻞ ﻧﻔﺲ ﺍﻷﻋﺮﺍﺽ ﻓﻲ ﺍﻟﺘﻼﺗﻪ ﺇﻳﻪ ﻫﻲ ؟؟
Mononucleosis
Anemia •
Repeated infection •
Bleeding •
ﻭﻣﻊ ﺫﻟﻚsever ﻫﻴﻜﻮﻥsore throat ﻃﻴﺐ ﺍﺧﺪ ﺑﺎﻟﻲ ﺍﻥ ﻓﻲ ﺍﻟﺤﺎﻟﺔ ﺩﻱ
No sever congestion •
No follicles nor pus •
Investigation ?
Blood picture
ﻭﺩﻱ ﻫﺘﻜﺸﻒ ﻭﻫﺘﺸﺨﺺ ﻟﻮ ﺍﻟﺴﺒﺐ
ﻣﻦ
Agranulocytosis •
Leukemia •
A plastic anemia •
الحالة الرابعة
33 Y OLD MAN COMPLAI N SEVER HEADACHE FOR THE PREVIOUS 12 HOUR S HE WAS
UNABLE TO TILT HIS N ECK WITHOUT PAIN HIS TEMP. 37.4 WITH HIGH BLOOD
PRESSURE
الحالة الخامسة
6 Y OLD GIRL SUFFER FROM PAIN IN RT SHOU LDER AND RT KNEE INCREASE D
TEMPERATURE AND ESR ABOVE 100
85 مايو
54 Y OLD MALE IN GEN ERAL HOSPITAL WITH A CUTE CHEST PAIN FOR 45 MINUTE
HIS ECG WAS NORMAL
) ﻭﺗﺒﺪﺃ ﺗﺘﻜﻠﻢ ﻋﻦ ﺍﻷﻣﺮﺍﺽ ﺍﻟﻤﻘﺘﺮﺣﺔessay (ﺃﻫﻢ ﺣﺎﺟﻪ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻧﻚ ﺗﻘﺪﺭ ﺗﺤﻮﻟﻬﺎ ﻝ
Investigations ??
x-ray
ECG
Cardiac enzymes
CT scan for aneurism
الحالة السابعة
12 Y OLD GIRL COME WITH CONVULSION WITH EYE PUFFINESS B L.P WAS 170/100
PAST HISTORY OF FEVE R AND SORE THROAT TR EATED WITH PENICILLI N
Diagnosis
Post strepto coccal glomerulonephrities
AB for infection
B – blocker + diuretic for controlling the bl.p
ﺧﺪ ﺑﺎﻟﻚ
ﺗﺒﻘﻰ ﺩﺍﺧﻠﻪ ﻋﻠﻰ ﺇﻳﻪconvulsion ﺍﻟﺒﻨﺖ ﻋﻨﺪﻫﺎ
Hyper tensive encephalopathy
ﻳﺒﻘﻰ ﻻﺯﻡ ﺍﺑﺪﺃ ﺑﻌﻼﺟﻬﺎ ﺃﻭﻻ
الحالة الثامنة
How to manage ??
ﻳﺒﻘﻰ ﻋﺎﻳﺰ ﺣﺎﺟﺘﻴﻦ
( diagnosis + treatment )
ﺃﻭﻻ
Diagnosis of pulmonary embolism
1- for D.V.T duplex scan on lower limb
2 – for lung lung scan
Blood picture show leukocytosis •
الحالة التاسعة
12 Y OLD BOY PRESCRIBED WITH FEVE R . MILD JAUNDICE FOR 5 DAYS WITH SORE
THROAT WELL GENERAL CONDITI ON TEMP. 38 , ENLARG ED LYMPH NODE OF AXI LLA
ﻟﻴﻪ ؟؟
Lymph node enlargement
ﻃﻴﺐ
( fever + jaundice)
ﺇﻳﻪ ﺇﻟﻲ ﻳﻌﻤﻠﻬﻢ
1 – viral infection ( EBV – CMV )
2 – asending cholangities
3 – fulminate liver failure
4 – hemolytic crisis
Prognosis ?
It is self limited
ﺑﺲ ﻋﻠﻰ ﻓﻜﺮﺓ ﻫﻮ ﻋﺮﺽ ﻟﻨﻮﻉ ﻣﻦ ﺍﻧﻮﺍﻉ ﺍﻟﻠﻴﻤﻔﻮﻣﺎ
Purpic cell lymphoma
الحالة العاشرة
SHE STATED THAT SHE DID NOT TAKE HER DRU G FROM A TIME THE PU LSE WAS
IRREGULAR IRREGULARI TY
5 DAYS LATER PAIN IN RT LEG AND HER FOOT WAS PALE AND COLD 5 DAYS MORE
SHE DEVELOP DIARRHEA AND SOFT DARK STOOL
Investigation ?
1 – ECG
2 – fundus examination
3 – Echo
Treatment ?
1 – hypotensive drug
2 – control of the heart
3 – anti coagulant after control of melena
55 Y OLD MALE SMOKE 30 CIGARETTE / DAY W ITH SMOKER COUGH DEV ELOP
RECURRENT ACUTE CHES T INFECTION AFTER IT THE COUGH CHANGED AN D THE
SPUTUM CHANGED AND T HEN HE DEVELOP GENER A L WEAKNESS NUMBNESS AND
TINGLING
ﺍﻟﺘﺸﺨﻴﺺ
A case of bronchogenic carcinoma
ﻃﻴﺐ ﻭﺇﻳﻪ ﺍﻷﻋﺮﺍﺽ ﺍﻟﺘﺎﻧﻴﻪ ﺩﻱ ؟
Para malignant
Para malignant ﺇﻟﻲ ﺑﺘﺘﺎﺛﺮ ﺏsystems ﺇﻳﻪ ﺍﻛﺘﺮ ﺇﻝ
1 – endocrine
2 – CNS
COPD ﻻﻥ ﻓﻴﻪchest ﻭﻣﻨﺴﺎﺵ ﺇﻝ
cor pulmonale ﻣﻤﻜﻦ ﻳﻜﻮﻥ ﻓﻴﻪheart ﻭﺑﺮﺩﻩ ﺇﻝ
55 Y OLD MAN DIABETIC FROM 20 Y COME WITH LOWER LIMB EDEMA BLOOD
PRESSURE 180/100 LAS T MONTH ATT ACK OF PAIN IN RT LI ON REGION FEVER AND
DYSURIA DOCTOR GIVE HIM TETRACYCLINE , A NALGESIC AND IVP
Treatment ?
ﺃﺣﺎﻭﻝ ﺃﺩﻱ ﻣﻀﺎﺩ ﺣﻴﻮﻱ ﻣﺒﻴﺨﺮﺟﺶ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻜﻠﻰ ﺍﻭ ﺗﺄﺛﻴﺮﻩ ﻋﻠﻴﻬﺎ ﺑﺴﻴﻂ ﺯﻯ
3rd generation cephalosporin
IVP ﺛﺎﻧﻴﺎ ﺍﻟﻤﻐﺺ ﺍﻟﻜﻠﻮﻱ ﻳﻌﻤﻞ ﺍﺿﻄﺮﺍﺏ ﻓﻲ ﻭﻇﺎﺋﻒ ﺍﻟﻜﻠﻰ ﻭﺩﻩ ﻛﺎﻥ ﻳﻤﻨﻌﻨﻲ ﺇﻧﻲ ﺍﻋﻤﻞ
In addition it is hepatotoxicty and diabetic nephropathy
Investigations
1- sonar
2 – CT , MRI in suspected case
ﺗﻜﻤﻠﺔ ﺍﻟﺤﺎﻟﺔ
IVP showed stones in kidney and urine culture show gram –ve bacilli sensitive to
gentamycin
The doctor give him gentamycin 80ml/8h the case develop acidosis oliguria very
high blood createnin and urea
ﺍﻟﺪﻛﺘﻮﺭ ﺍﺧﻄﺄ ﻓﻲ ﺇﻳﻪ
ﻟﻢ ﻳﺮﺍﻋﻲ ﺍﻷﻋﺮﺍﺽ ﺍﻟﺠﺎﻧﺒﻴﺔ ﺍﻟﺨﻄﻴﺮﺓ ﻟﻠﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻮﻳﺔ ﺍﻟﻤﺴﺘﺨﺪﻣﺔ ﻭﺧﺼﻮﺻﺎ ﺍﻧﻪ ﻣﺮﻳﺾ ﺳﻜﺮ
ﻭﻭﻇﺎﺋﻒ ﺍﻟﻜﻠﻰ ﻋﻨﺪﻩ ﻣﻀﻄﺮﺑﺔ ﻭﺑﺎﻟﺘﺎﻟﻲ ﺩﺧﻞ ﺍﻟﻤﺮﻳﺾ ﻓﻲ ﻣﻀﺎﻋﻔﺎﺕ ﻫﻮ ﻓﻲ ﻏﻨﻰ ﻋﻨﻬﺎ
ﻣﻌﻠﻮﻣﺔ ﻫﺎﻣﻪ
Gentamycin should adjusted to blood createnin